Low T4, normal TSH

[ROJAS123]

My TSH levels are normal but my T4's are low.  Not sure what this means since if my pituitary glands are producing enough TSH what is happening to make my T4's low?
Doctor wants we to take a THS 3rd generation and a CBC and basic Metab panel.

I have all the symptoms of hypothyroid, depression, fatigue weight gain, joint pain, have cold hands and feet and got grey hair at a very early age as well as suffered infertility but she has not mentioned that and just told me to take these additional tests, so I am confused.
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[Arunangshu]

My T3 is 69.70 and T4 is 4.74 while TSH 3rd gen is 2.6 .. what do these figures indicate ? I feel the fatigue and cold hand and feet.

[gimel]

What are the reference ranges for the T4 and T3, as shown on the lab report?  

[lemay]

Thank you so much! I'm going to email my doctor tonight. I always feel like I'm going to "offend" him if I question things and request more tests. But, having said that, I would have never known I was hypo without demanding tests to begin with. The levothyroxine has helped tremendously with anxiety, depression and panic attacks but physically, I still feel "off". Thanks again and I'll post new results as you mentioned above.

[gimel]

The jeopardy with your new lab results is that if the doctor has the "Immaculate TSH Belief' and only really pays attention to TSH, then you might be told that all is well and no further increase in meds is required.  Not so.   Your Free T4 is below level we consider minimum which would be 1.25 (middle of the range).  You weren't even tested for Free T3 which is the most active thyroid hormone.  FT4 and FT3 should be tested every time you go in for tests.  If your Free T3 is as low in its range as your Total T3, that will be very indicative of being hypothyroid.  

A good thyroid doctor will treat a hypo patient by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.  Symptom relief should be all important, not just test results, and especially not TSH.  I say that because hypo patient taking adequate thyroid medication often find that their TSH becomes suppressed, and the doctor reacts by reducing meds.  That is not correct unless the patient is  having hyper symptoms due to excessive levels of Free T4 and Free T3.  So your med dosage is only a starter dose and you need to be gradually increased as needed to relieve symptoms.  

Also hypo patients are frequently too low in the ranges for Vitamin D, B12 and ferritin.  Low levels can cause symptoms.  Low D or low ferritin can also adversely affect metabolism of thyroid hormone.  D should be about 55-60. B12 in the upper end of its range, and ferritin about 70 minimum.  After testing you can supplement as needed to optimize.  

[lemay]

You were right, Gimel, about having a doctor that really just looks at the lab ranges and dismisses you. Due to increased symptoms, I requested additional testing as you recommended. He didn't want to do them and basically told me he didn't think they were necessary but he would order them and that there was no difference between Levothyroxine and brand-name medications.  Wow.

TSH (Range 0.10-5.50 uiv/ml)
12/1/15 - 1.7
1/8/16 - 2.7

Free T4 (Range 0.8-1.7 ng/dl)
12/1/15 - 1.0
1/8/16 - 1.0

T3 Total (Range 50-170 ng/dl)
12/1/15 - 85
1/8/16 - 87

B-12 (Range }=200 pg/ml)
1/8/16 - 572 pg/ml

Ferritin (Range 22-291 ng/ml)
1/8/16 - 107 ng/ml

Calcium (Range 8.5-10.3 mg/dl)
1/8/16 - 9.8 mg/dl

Magnesium (Range 1.7-2.3 mg/dl)
1/8/16 - 2.0 mg/dl

He still didn't order the Free T3 and I specifically requested it. I'm not happy at all with his dismissive attitude. Actually asked me if I wanted antidepressants.   Lol.

Why is my TSH going back up??

[lemay]

Oops, meant to do that.

TSH 1.71 uIU/mL (Range 0.10 - 5.50)
T3 Total  85 ng/dL (Range 50 - 170 ng/dL)
Free T4 is 1.0 ng/dL (Range 0.8 - 1.7 ng/dL)
Cortisol 8:00 AM 23.7 ug/dL (Range 8.0 - 25.0 ug/dL)

Im glad my TSH is down but I feel my T4 and T3 are on the low end of ranges. Doing a suppressed Cortisol test next week.

[gimel]

Please post the reference ranges for the Free T4, Total T3 and cortisol tests, as shown on the lab report.  The reason I ask is that results and associated ranges will vary from lab to lab so results should always be compared to ranges from same lab.

[lemay]

Started on .25 Levo 2 months ago. After 2 years of being told my symptoms were menopause and offering antidepressant and counseling, I finally demanded more tests.  TSH was 4.5 and FREE T4 was 1.0.  Was told it was borderline hypothyroid and began treatment. Also Cortisol at 8:00 am was 23.7 ug/dl, which doctor said was elevated.  Most recent labs are TSH is 1.8, Free T4 is 1.0 and Total T3 is 80. These are Kaiser labs. Wondering if my T4 and T3 are still low. I feel better on meds, but still off, horrible sleep, retaining water, fat face, weight gain. I'm 5'4 and 149 lbs. I've gained 25 lbs in one year before diagnosis.